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Frequently Asked Questions Insurance

Multi State Plan Program

A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.

A Multi-State Plan insurer must offer a benefits package that is uniform within each State and includes “essential health benefits” in the following categories:
1.Ambulatory patient services
2.Emergency services
3.Hospitalization
4.Maternity and newborn care
5.Mental health and substance use disorder services, including behavioral health treatment
6.Prescription drugs
7.Rehabilitative and habilitative services and devices
8.Laboratory services
9.Preventive and wellness services and chronic disease management
10.Pediatric services, including oral and vision care
A Multi-State Plan insurer must also offer any additional benefits required under its State’s laws.

A Multi-State Plan (MSP) insurer must make its provider directory for each MSP option available to the Marketplace for publication online and to you in hard copy if you ask for it. In the provider directory, an MSP insurer must identify providers that are not accepting new patients.

It depends. While OPM is encouraging statewide coverage in the Multi-State Plan (MSP) Program, it is not required of MSP insurers at this time. OPM is, however, requiring MSP insurers that offer partial coverage in a State to submit a plan for extending coverage throughout the State.

No, MSP options are not generally more expensive than other plans on the Marketplace. However, the prices for all options on the Marketplace may vary depending on whether they are bronze, silver, or gold level plans.

You will want to review the benefits covered by any plan you are considering to see if your children’s out-of-State providers are included in the plan’s network. Services provided by health care providers outside of a plan’s network typically cost more than services delivered by in-network providers.

OPM holds meetings and phone calls with stakeholders to seek input, as well as address questions and concerns. OPM also conducts presentations at national meetings and conferences and holds office hours to obtain feedback from interested parties.

When you get health insurance coverage in the Marketplace, you may be eligible for subsidies that can lower your monthly premiums. This depends on your income and family size. Enrollees in Multi-State Plan options may qualify for this financial assistance.

As a general rule, Multi-State Plan (MSP) insurers have to comply with applicable State laws. The Affordable Care Act reserves the possibility that certain exceptions to State law may become necessary for appropriate OPM oversight of the program.

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